The present disclosure relates to a manipulating apparatus for holding and handling instruments for minimally invasive procedures, comprising a frame and at least one instrument carrier comprising a holding section for holding an instrument arm. The disclosure further relates to a manipulating system for minimally invasive surgical operations and further procedures. In exemplary embodiments, the disclosure further relates to a remote manipulating system for minimally invasive single-port-operations, comprising a control platform that is provided with such a manipulating apparatus.
More generally, the present disclosure relates to the field of minimally invasive surgery and the field of robotic operation systems and/or the field of robotic remote operation systems. For minimally invasive procedures, surgeons generally use natural body openings or artificially created body openings so as to insert several instruments into the interior of the body of a to-be-treated person and/or a to-be-treated animal. Minimally invasive procedures may involve procedures of therapeutic nature, procedures of diagnostic nature and combinations thereof. It is generally desired to use access openings to the body that are small as possible so as to minimize the stress to the patient as much as possible. Frequently, instruments for minimally invasive procedures enable only limited movements and/or operations in the interior of the body.
WO 96/39944 A1 discloses a surgical instrument manipulator, comprising an affixable carrier base, an instrument holder that is movably arranged at the carrier base and adapted to hold a surgical instrument in a releasable fashion, a driving arrangement, and a coupling device, wherein the instrument holder comprises a body and an instrument carrier that is movably attached to the body and provided with an interface which is arranged to be coupled with the surgical instrument so as to attach the instrument to the instrument holder in a releasable fashion, wherein the driving arrangement is operatively coupled with the instrument holder so as to provide the instrument with at least two degrees of freedom including a rotation of the surgical instrument with respect to the carrier base and an axial movement of the surgical instrument with respect to the carrier base, wherein the driving arrangement comprises a first controllable and/or steerable motor that is operatively connected with the instrument carrier so as to move the same, and a second steerable and/or controllable motor that is operatively connected with the body of the instrument holder so as to move the same with respect to the carrier base, wherein the coupling device is arranged for releasably mounting the instrument holder to the carrier base and the driving arrangement, and wherein the instrument holder is removable from the carrier base and the driving arrangement for sterilization.
For quite some time now, systems for robotic operations, for instance in the field of remote medicine, are at the stage of research and testing. In the past, generally an approach was pursued that involved an adaption of known functional principles from the field of (industrial) robotics and/or industrial production, assembly and handling to the field of medical technology. Approaches of that kind, however hit limits when particular requirements in the field of minimally invasive surgery are addressed.
Surgical instruments for minimally invasive procedures typically comprise an elongated shape at a very small diameter. Nevertheless, there is also a need for instruments which may perform extended functions in the interior of the body. This may for instance involve a pivotability about at least one pivot axis and the actuation of surgical tools which are arranged at the distal end of the instruments. A common diameter of instruments for minimally invasive procedures is for instance 10 mm (millimeter). This installation space restriction poses high requirements to mechanical, optical and electronic components for such instruments.
Frequently, a plurality of instruments is used in a minimally invasive procedure. This may also take place in a simultaneous fashion. In other words, often two or even more instruments are simultaneously inserted in the interior of the patient. By way of example, this may involve a simultaneous use of an endoscopic instrument for monitoring and a surgical instrument for the procedure as such.
Further, so-called single-port-operations and multi-port-operations are known. With single-port-operations, the procedure is performed at merely one opening in the body. With multi-port-operations, a plurality of body openings is used. It is generally desired to use as few body openings as possible so as to minimize the stress for the patient. However, when two or more instruments are simultaneously inserted in the interior of the body of the patient, and when this takes place about merely a single access, the installation space restrictions are even further increased. Known manipulators or robots for medical applications may then reach their limits. This is sometimes attributable to the fact that the instruments that are to be inserted in a simultaneous fashion may (outside of the body) be simply not guided in a fashion sufficiently close to one another and/or oriented with respect to one another to be inserted in the interior of the body in a parallel fashion, for instance.
Medical instruments for operative procedures which are arranged to be pivoted about more than one axis are for instance known from US 2015/0119918 A1. In this way, the freedom of movement in the interior of the body can be remarkably increased. Generally, there is a need for instruments including an increased number of degrees of freedom. The degrees of freedom may for instance relate to degrees of freedom of movement (longitudinal movements, pivot movements, rotations). Degrees of freedom may, however, also relate to the actuation of surgical tools (scissors, forceps, etc.) which are again attributable to movements. The more the degrees of freedom are implemented in an instrument, the more paths for motion transmission and/or for transmission of forces and/or torques have to be considered. In a shaft of an instrument or an arm of an instrument, movements generally may be transmitted by pull/push or by rotation movements. The more complex the instrument is arranged and the more degrees of freedom are present, the more complex and sluggish is the operation of the instrument. Hence, motor-supported or motor-aided manipulating systems for surgical procedures may be an option also in cases when the aspect of remote medicine is not or not exclusively addressed.
Medical manipulating systems for instruments having a plurality of degrees of freedom (for instance two, three or four degrees of freedom in the instrument itself) may significantly facilitate the operation of the instrument, as a purely mechanical actuation is on the one hand exhausting and on the other hand very challenging in terms of coordination. Accordingly, a workplace may be provided for the operating surgeon that includes respective input elements, for instance joysticks, dummy-instruments and/or phantom instruments and such like. In this way, the operating surgeon may create movement signals which may be converted by a control device of the manipulating system into control signals for drives that in turn convert those signals into movements.
In view of this, it is an object of the present disclosure to present a manipulating apparatus for surgical instruments and a manipulating system comprising such a manipulating apparatus.
It is a further object of the present disclosure to present a manipulating apparatus for surgical instruments and a manipulating system comprising such a manipulating apparatus that are suitable for surgical instruments or medical instruments having an enhanced functional scope.
It is a further object of the present disclosure to present a manipulating apparatus for surgical instruments that is suited for instruments that provide an increased number of (mechanical) degrees of freedom and/or degrees of freedom of movement.
It is a further object of the present disclosure to present a manipulating apparatus that is suited for single-port-operations.
It is a further object of the present disclosure to present a manipulating apparatus that is suited for the simultaneous use of at least two instruments that are simultaneously inserted in the body of a to-be-treated patient.
It is a further object of the present disclosure to present a manipulating apparatus that further increases the functional scope of the instrument, for instance by providing at least a further (movement) degree of freedom.
It is a further object of the present disclosure to present a manipulating apparatus that enables a simple instruments change.
It is a further object of the present disclosure to present a manipulating apparatus that, when in operation, contributes to a reproducible and predictable behavior of the instruments during the operations.
It is a further object of the present disclosure to present a manipulating apparatus that contributes to a high absolute positioning accuracy and a high relative positioning accuracy and repeatability of the instruments.